Patient Rights and Privacy:

At Spine Hospital of Louisiana (SHOLA), we are concerned that each patient entrusted to our care is treated with dignity, respect, and compassion. We recognize that all patients have basic rights, and we are committed to honoring these rights. Likewise, SHOLA has a right to expect reasonable and responsible behavior from patients, their relatives, and friends. The following is a summary of rights and responsibilities that we believe serve as a foundation for a good relationship between patients and staff.

Receive Care and Support:

• Be informed of their rights and responsibilities in advance of furnishing or discontinuing patient care
• Professionally receive treatment and medical services without discrimination based on race, color, ethnicity, age, religion, national origin, sex, sexual orientation, gender identity or expression, handicap, diagnosis, physical or mental disability, or socioeconomic status
• Participate in the development and implementation of their plan of care, continued care planning, and treatment
• Be informed of the results of care, treatment, and services so they may ask questions and participate in current/future healthcare choices
• Participate in discharge planning and be provided with information on how to have their care and needs met at home, along with information, resources, and services as needed
• Make informed decisions regarding their care
• Be informed of their health status and be able to request or refuse treatment
• Receive appropriate initial and ongoing assessment and management of pain. The Physicians, Anesthesia, and staff coordinate and support activities and resources to ensure that your pain is recognized and addressed in a timely manner
• Be informed if the hospital has authorized other health care and/or educational institutions to participate in their treatment, and the right to know the identity and function of these institutions and the right to refuse to allow their participation in the patient's treatment
• Receive, as soon as possible, services of a translator or interpreter to facilitate communication between them and the hospital's health care personnel after they notify SHOLA
• To have access to aids and services for people with disabilities to communicate effectively with SHOLA, such as a qualified sign language interpreter and written communications in different formats, such as audio or large print
• To formulate advance directives and have hospital staff and practitioners who provide care in the hospital comply with these directives

Personal privacy and visitation:

Be treated with dignity, respect, and recognition of their individuality, including the need for privacy in treatment and the right to privacy:

• Have their health information kept confidential per federal and state law
• Be informed of the names and functions of all physicians and other health care professionals providing direct care to them, who will be identified by an introduction and/or wearing a name tag
• Have a family member, friend, or other person with them to provide emotional support unless doing so is disruptive
• Be safe and have their rights respected during research, investigative, and clinical studies

Security and Safety:

• Be free from restraints of any form that are not medically necessary or used as a means of coercion, discipline, convenience, or retaliation by staff
• Be free from all forms of abuse and harassment
• Be free from mistreatment and neglect
• To receive care in a safe setting that meets personal needs and preserves dignity
• To be transferred to another facility only with a full explanation of the reason for transfer, provisions for continuing care, and acceptance by the receiving institution, except in cases of emergencies
• Say yes or no to the making of recordings, images, films, or other pictures other than for identification, diagnosis, or treatment
• Receive resources on supportive, protective, and patient advocacy if needed
• Have customs and personal values, beliefs, and preferences respected as long as they do not interfere with treatment and receive religious and other spiritual services

Information

• To access and obtain their medical records, including all computerized medical information in their medical records, within a reasonable time frame upon written request that complies with SHOLA's HIPAA-compliant Authorization for Release of Patient Information
• To examine and receive an explanation of the hospital bill regardless of the source of payment and receive, upon request, information relating to financial assistance available through the hospital

Express Concerns, Complaints, or Grievances

• To be informed in writing about the hospital's policies and procedures for initiating, reviewing, and resolving patient complaints, including the address and telephone number where complaints may be filed
• To express concerns about any part of their care, treatment, or services
• To safely express concerns or feelings when scared or hurt
• A grievance may be filed with our CNO by emailing PatientRelations@spinehola.com or by calling 225 906 4802. For any Privacy or Compliance issues, please contact our Privacy and Compliance Officer, by email Compliance@Spinehola.com or calling 225-768-2736. Complaints may be filed with the Louisiana Dept of Health, Standards Section, Complaint Program Desk, P.O. Box 3767, Baton Rouge, LA 70821-3767 Tollfree phone: (866)280-7737 or Local phone: (225) 342- 5775 or Local fax: (225) 342-5073, or by email at HHSComplaints@LA.GOV or by filing a civil rights complaint with the U.S. Department of Health and Human Services (HHS), Office of Civil Rights, electronically through the office for Civil Rights Complaint Portal, at https://orcportal.hhs.gov/ocr/portal/ lobby.jsf, or by mail or phone at HHS, 200 Independence Ave, S.W., Room 509F, HHH Building, Washington, D.C. 20201, (800) 368-1019, (800) 537- 7697 (TDD)

B. РАTIENT RESPONSIBILITIES - the care a patient receives depends partially on the patient himself/herself. In addition to the above rights, a patient has specific responsibilities presented in the spirit of mutual respect and trust.

It is the responsibility of the patient to:

• Comply with SHOLA's hospital rules
• Cooperate in their own treatment
• Provide a complete and accurate medical history, both present and past
• Provide complete and accurate information about changes in health problems or symptoms, primarily pain and unexpected changes in conditions
• Provide complete and accurate information of all medication taken or changed, including supplements, pain, and all drugs they are taking or no longer taking
• Be respectful of other patients, staff, and property
• Provide complete and accurate personal information required regarding payment of charges, including names, aliases, phone numbers, email addresses, date of birth, social security number, health insurance coverage information, and other relevant information
• Give SHOLA a copy of an advanced directive, living will, or written legal documents that are related to decision-making regarding their healthcare
• Tell SHOLA if they need a translator/translation services
• Speak up and ask questions until they understand their treatment, procedure, medications, and instructions before and after any visit with SHOLA
• Aid in making choices about their healthcare and treatment by working with their doctor, nurse, or other healthcare providers and staff
• Inform any team member as soon as possible if they have any questions, issues, problems, or concerns
• Work with staff to develop a care and or pain management plan
• Follow their specific instructions and plan of care or be responsible for their actions should they refuse treatment or not follow the physician's orders
• To report perceived risks in their care to the responsible practitioner
• Be responsible in paying their bills, meeting their financial responsibilities, and making arrangements for their financial responsibilities
• Leave their personal belongings and valuables at home or have someone take all valuables home.
• Show respect and consideration to all around them while respecting the rights of others, all staff members, and other patients
• Treat all visitors, patients, providers, and team members with respect and courtesy, helpfulness, and thoughtfulness
• Keep their scheduled appointments and call as soon as possible if they must change them
• Not be abusive or have any rude behavior which may result in their dismissal from SHOLA's care or arrest if they assault anyone while on SHOLA property, which is a felony under § R. S. 14:38, and under other applicable criminal laws
• To not smoke or use tobacco products, including ecigarettes, in or around or property
• Not leave their assigned area of care without speaking with staff members
• Not bring any weapons, drugs, alcohol, guns, and any other type of similar item onto SHOLA property
• Not take photos/videos of other patients/ people